final exam Flashcards
What does the ‘Hierarchical Taxonomy of Psychopathology’ (HiTOP) depict?
It is a framework for understanding the dimensional aspects of symptoms, along with the underlying biological and environmental influences on, different kinds of psychiatric disorders.
Allows for mental health conditions to be represented in terms of severity, intensity and comorbidity rather than the categorical boundaries within the DSM-V
What are the main components of Spence and Rapee’s model of social anxiety disorder?
Performing avoidance/safety behaviours provides relief that reinforces the social anxiety.
Heightened physiological arousal from anxiety can also reinforce that a social situation is threatening/dangerous
What are the biological “fear response” factors that have been shown to be associated with social anxiety disorder?
Neurotransmitters: serotonin, norepinephrine, dopamine
Neuroanatomy:
- increased fear circuit amygdala activation
- reduced hippocampal volume
What are the environmental factors implicated in the development of social anxiety disorder?
- Parenting style -> parent-child attachment
- Parent modelling and direct conditioning of behaviours
- Peer experiences (rejection, teasing, bullying)
What are the evaluative processes that occur before a social situation in an individual with social anxiety disorder?
- Anticipatory processing
- Avoidance behaviours
What are the evaluative processes that can occur during a social situation in an individual with social anxiety disorder?
- Self-focus
- Safety or escape behaviour
- Cognitive avoidance
- Attentional bias to threat
- Performance deficits
What are the biological factors for generalised anxiety disorder?
- Functional deficiency of GABA neurotransmission
- Reduced volume in the hippocampus, anterior cingulate cortex and amygdala
What are the two levels of worry in Well’s ‘meta-cognitive model’ of generalised anxiety disorder?
- Everyday events -> worry is excessive and out of proportion
- Worry about worry (meta-beliefs)
Plus: unhelpful behaviour such as avoidance or reassurance seeking
Describe the intolerance of uncertainty model?
When considering anxiety inducing situations, individuals with generalised anxiety disorder tend to focus on the ambiguous or uncertain aspects of that situation.
People with GAD have a low tolerance for ambiguous situations, which can increase anxiety and discomfort
What issues in the DSM-V does the HiTOP model address?
- Arbitrary boundaries between psychopathology and normality
- Unclear boundaries between disorders
- Frequent co-occurrence and heterogeneity of disorders
- Diagnostic instability
Describe the interplay between stress, fear and anxiety
Fear and anxiety are usually adaptive processes which involve sympathetic nervous system activity (arousal). Anxiety helps to notice and plan for future threats, whereas fear is fundamental for fight-or-flight reactions.
When the body’s fear response is activated in situations where there is no real danger, it can lead to excessive and chronic levels of stress. The more anxious a person becomes, the more sensitive their body becomes to stress and fear, and the more easily triggered their anxiety becomes.
What behaviours/processes does intolerance of uncertainty interact with?
- Positive beliefs about worry: rationalisation of worry
- Poor problem orientation and low confidence
- Negative reinforcement through avoidance behaviours
What does the meta-cognitive model of worry suggest about anxiety?
The symptomology of anxiety disorders is influenced by negative appraisals of worry (meta-cognitions). Type 1 worry does not constitute a pathology, whereas negative beliefs about worry is what maintains anxiety.
Meta-worry causes an escalation in anxiety and interferes with the use of effective forms of mental control.
What are the cross-national trends for anxiety disorders?
In 2000-2021, approximately 16.8% (3.3 million people) had a 12-
month Anxiety disorder in Australia
What are the factors of this symptom in the DSM-V:
1. Depressed or irritable mood
- Constant negative affective state, tearfulness, irritability, pessimism
- Present for the majority of the day, nearly every day, for at least 2 weeks
What are the factors of this symptom in the DSM-V:
2. Anhedonia
- Impaired ability to experience either pleasure or interest
- Loss of interest in anything found to be enjoyable in a pre-depressive state
- Reduced motivation
What are the factors of this symptom in the DSM-V:
3. Appetite/weight disturbances
- Hypophagia: stress decreases desire to eat, often resulting in weight loss
- Hyperphagia: stress increases desire to eat, often resulting in weight gain
- Daily fluctuations in appetite, or unintentional change of 5% in body weight within 1 month of other symptoms
What are the factors of this symptom in the DSM-V:
4. Sleep disturbances
Exacerbates other symptoms: memory, mood, concentration
- Insomnia: chronic inability to sleep (initial, terminal or middle forms); 85% prevalence
- Hypersomnia: daily excess of 10hrs of sleep (not restful, increased daytime sleep); 48% prevalence
What are the factors of this symptom in the DSM-V:
6. Fatigue
- Lethargy linked to mental or physical exertion
- 2nd most reported symptom (73-97%)
- Exacerbates other symptoms
What are the factors of this symptom in the DSM-V:
5. Psychomotor disturbances
- Agitation: feelings or behaviours of restlessness (can’t sit still, talkative, distracted, racing thoughts, mood switches)
- Slowing: slow thoughts/behaviour (poor eye contact, fixed gaze, poor posture, flat)
What are the factors of this symptom in the DSM-V:
7. Feelings of guilt or worthlessness
- Guilt: feeling bad about uncontrollable circumstances, placing blame on self
- Worthlessness: inadequacy, low self-esteem, self-loathing; affects 80-85%
What are the factors of this symptom in the DSM-V:
8. Concentration or memory impairments
- Impaired executive functioning
- Lowered cognitive inhibition
- Reduced capacity to problem solve
- Reduced mental flexibility
What are the factors of this symptom in the DSM-V:
9. Suicidal Ideation
- Passive: thoughts without intent
- Active: thoughts with intent to act
- SLAP Assessment: specificity, lethality, availability, proximity
- 78-89% consider, attempt, contemplate
What is the kindling effect in MDD?
Repeated exposure to stressors + neurochemical changes = more frequent depressive episode without clear cause
What are the global and national prevalence estimates of MDD?
Global: 322 million people = 4.5% population; 5.5% males, 3.6% females
Australia: 12-month prevalence 10.4%; 11.6% females, 9.1% males
Describe the heterogeneity in MDD symptom profiles
227 potential presentations that qualify for diagnosis, caused by interaction between pathogenesis and aetiological factors
What are main assessment tools for MDD in adults?
Clinician administered:
Mini International Neuropsychiatric Interview (MINI)
Hamilton Depression Rating Scale (HAM-D)
Montgomery-Asberg Depression Rating Scale (MADRS)
Self-report:
Beck Depression Inventory (BDI-II)
Depression, Anxiety, and Stress Scale (DASS)
Centre for Epidemiological Studies Depression Scale (CES-D)
Patient Health Questionnaire (PHQ-9)
What are the main assessment tools for MDD in both children and older adults?
Children:
Child Behaviour Checklist (CBCL)
Children’s Depression Rating Scale (CDRS)
Older Adults:
Geriatric Depression Rating Scale (GDRS)
Describe Beck’s cognitive model of depression
Stressful life events in early life shape schemas.
Negative cognitive schemas are triggered by negative interactions, repeated activation leads to an attentional bias towards negative stimuli
Describe the learned helplessness model of MDD
When a person believes that they have no control over their circumstances they will begin to behave as if they are helpless, which is a learned behaviour/belief.
Universal: nothing can be done about the situation -> external attributions
Personal: other’s could fix the situation, but not the individual -> internal attributions
Both universal and personal types cause depressive symptoms as the individual learns/believes to not expect change
What is the monoamine hypothesis of depression?
Low levels of serotonin, norepinephrine and dopamine in the brain are related to depressive symptoms:
- Norepinephrine: energy, alertness, concentration
- Dopamine: reward, anhedonia
- Serotonin: mood, appetite, anxiety, suicidal ideation
How is the HPA axis hypothesised to be related to depression?
Hypothalamic Pituitary Adrenal axis is responsible for feedback loops between the brain and pituitary/adrenal glands which are involved in the stress response (and others) by modulating the release of cortisol and other neuroendocrinic factors.
Hyperactivity of the HPA axis has been shown to relate to depressive symptoms
What does the prefrontal cortex do ?
Regulates executive function -> broader changes in activation patterns is thought to be due to repeated exposure to stress hormones
What does increased activity in the ventromedial prefrontal cortex predict?
Negative emotions, such as low mood and fear
What does increased activity in the orbitofrontal prefrontal cortex predict?
Decreased emotional regulation
What does increased activity in the dorsolateral prefrontal cortex predict?
Deficits in memory, attention and reasoning